Dell Children’s Comprehensive Epilepsy Center Mark R. Lee, MD, PhD, FACS Pediatric Neurosurgery Co-Director of the Comprehensive Epilepsy Center Dell Children’s Medical Center Dave F. Clarke, MBBS, D-ABPN, D-ABCN, D-ABSM Pediatric Epileptologist Director of the Comprehensive Epilepsy Center Dell Children’s Medical Center
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Dell Children’s Comprehensive Epilepsy Center
Mark R. Lee, MD, PhD, FACS Pediatric Neurosurgery Co-Director of the Comprehensive Epilepsy Center
Dell Children’s Medical Center
Dave F. Clarke, MBBS, D-ABPN, D-ABCN, D-ABSM Pediatric Epileptologist Director of the Comprehensive Epilepsy Center
Dell Children’s Medical Center
Disclosure Information AACPDM 70th Annual Meeting | September 20-24, 2016
Speaker Name:
Disclosure of Relevant Financial Relationships I have the following financial relationships to disclose:
Consultant for: (None)
Speaker’s Bureau for: (Lundbeck, Livanova)
Grant/Research support from: (GW pharmaceuticals, the Anderson Foundation)
Royalties from: (None)
Stockholder in: (None)
Honoraria from: (None)
Employee of: (None)
• 5 year old female with Focal onset epilepsy
• Presented in 8/2010 in EPC then focal status
• Eye dev to right, Focal Rt. hemi-body activity face followed by UE>LE
Case 1
Initial treatment of epilepsy Sankar R et al Neurology 2004;63(Suppl 4): S30-S39
Choices: Seizure type and Epilepsy Syndrome (Wheless JW, Clarke DF et al. 2007)
Tolerability Age specific toxicity
Overall Health Learning and Behavior
Phenobarbital and neurocognitive performance (Vining et al. Pediatrics 1987)
Impulsivity and Hyperactivity of Phenobarbital Behavioral adverse effects of Keppra Behavioral and cognitive abn. With Topiramate (Gerber et al.Pediatric Neurol, 2000)
Comorbidities (Dunn DW et al. Psychiatry et al. 1999;53(suppl 2):S17-23)
Depression ADD Migraine Symptoms of ASD ( Clarke DF et al. Epilepsia, 2005; Tuchman R J Autism Dev Disorder, 2000)
Sleepiness – May affect behavior (Clarke DF et al. 2005 )
Seizure frequency
Meds tried in this patient: Keppra, Vimpat, Ativan, Pht, Zonisamide failed to control her seizures
AED Efficacy
1st AED 2nd AED 3rd AED Duotherapy
Newly diagnosed epilepsy =470
Uncontrolled
seizures 53%
Uncontrolled seizures 40%
Uncontrolled seizures 39%
Uncontrolled seizures 36%
Seizures-free 47%
Seizures-free 13%
Seizures-free 1%
Seizures-free 3%
Kwan P et al. N Engl Med. 2000;342 (5):314-319
Approximately 40% of patients with epilepsy have pharmacoresistant seizures.*
• Focal resection of the prefrontal area approximating the midline - the left superior and middle frontal gyrus
• Seizure free for 13 months
• Neuro-cognitively doing much better, socializing well
• 14 months after resection - Presents with elevation of right or bilateral upper extremity
• 2-3/wk
Does she have Epilepsy?
Tic disorder
Scope of the problem
• Methods: 127 children seen in a tertiary care First Seizure Clinic. (1 month -17 years)
• Results: – Non-epileptic in 31 (24%) and unclassifiable in two (2%).
– Pediatricians were more likely to refer true epileptic events (92%) than ED physicians (76%) or family physicians (65%).
This study recruited 127 healthy participants (female/male: 72/55; mean age: 22.7 3.4; all right-handed). Diffusion tensor images (DTI) were acquired using a Siemens 3T MR system.